Citation Nr: 0006416
Decision Date: 03/09/00 Archive Date: 03/17/00
DOCKET NO. 96-07 590 ) DATE
)
)
On appeal from the
Department of Veterans Affairs Regional Office in Reno,
Nevada
THE ISSUES
1. Entitlement to service connection for a chronic acquired
psychiatric disability.
2. Entitlement to service connection for chronic right
shoulder disability.
3. Entitlement to service connection for chronic back
disability.
REPRESENTATION
Appellant represented by: AMVETS
WITNESS AT HEARING ON APPEAL
Appellant
ATTORNEY FOR THE BOARD
Artur F. Korniluk, Associate Counsel
INTRODUCTION
The veteran had active service from July 3 to November 7,
1969. This matter comes to the Board of Veterans' Appeals
(Board) from the Department of Veterans Affairs (VA) Reno
Regional Office (RO) May 1995 rating decision which denied
service connection for a "mental condition," right shoulder
and low back disabilities. In May 1998, the case was
remanded to the RO for additional development of the
evidence.
On January 28, 2000, the veteran's representative submitted
to the Board additional evidence which was not previously of
record (consisting of a summary of outpatient psychiatric
treatment from the veteran's psychiatrist, covering the
period June 1999 to January 2000). Initial consideration of
this material by the RO has not been waived pursuant to
38 C.F.R. § 20.1304(c) (1999). However, as such material is
essentially cumulative of evidence already of record at the
time of the July 1999 supplemental statement of the case and
merely updates the current status of the veteran's health,
referral thereof to the RO for initial consideration is
unwarranted in this case. Id. Moreover, such material was
submitted to the Board more than 90 days following the
October 22, 1999 mailing of notice to the veteran and his
representative that the appeal had been certified to the
Board for appellate review; the newly submitted evidence was
not accompanied by a motion demonstrating good cause for
delay in submitting such evidence. 38 C.F.R. § 20.1304(a),
(b).
FINDINGS OF FACT
1. The veteran sustained a fall in service, injuring his
legs and back, and continued to have left knee problems after
medical treatment from August to October 1969; symptoms of
impairment involving the right shoulder, the back, and/or
psychiatric disability were not evident at the time of
service separation in November 1969.
2. He experienced emotional/psychiatric problems prior to
service entrance, but pertinent symptoms or impairment were
not evident in service or for many years thereafter; medical
evidence of record demonstrates that his current psychiatric
disability is not related to active service or any incident
occurring therein.
3. Chronic disability of the veteran's right shoulder and
back were not evident at the time of service separation or
for many years thereafter, and competent medical evidence
demonstrates that his current right shoulder and back
disabilities are related to post-service causes.
CONCLUSIONS OF LAW
1. The veteran's chronic psychiatric disability was neither
incurred in nor aggravated by active wartime service. 38
U.S.C.A. §§ 1110, 5107 (West 1991); 38 C.F.R. §§ 3.303,
3.307, 3.309 (1999).
2. His chronic right shoulder disability was neither
incurred in nor aggravated by active wartime service. 38
U.S.C.A. §§ 1110, 5107 (West 1991); 38 C.F.R. §§ 3.303,
3.307, 3.309 (1999).
3. His chronic back disability was neither incurred in nor
aggravated by active wartime service. 38 U.S.C.A. §§ 1110,
5107 (West 1991); 38 C.F.R. §§ 3.303, 3.307, 3.309 (1999).
REASONS AND BASES FOR FINDINGS AND CONCLUSIONS
Service connection may be allowed for a chronic disability,
resulting from an injury or disease, incurred in or
aggravated by the veteran's period of active wartime service.
38 U.S.C.A. § 1110. Service connection may also be allowed
on a presumptive basis for psychosis and arthritis, if the
pertinent disability becomes manifest to a compensable degree
within one year after the veteran's separation from service.
38 U.S.C.A. §§ 1101, 1112, 1113, 1137 (West 1991); 38 C.F.R.
§§ 3.307, 3.309 (1999).
For a showing of chronic disease in service there is required
a combination of manifestations sufficient to identify the
disease entity, and sufficient observation to establish
chronicity at the time, as distinguished from merely isolated
findings or a diagnosis including the word "chronic."
Continuity of symptomatology is required when the condition
noted during service is not, in fact, shown to be chronic or
where the diagnosis of chronicity may be legitimately
questioned. When the fact of chronicity in service is not
adequately supported, a showing of continuity after discharge
is required to support the claim. 38 C.F.R. § 3.303(b)
(1999).
A veteran is presumed to be in sound condition when examined
and accepted into the service except for defects or disorders
noted when examined and accepted for service or where clear
and unmistakable evidence establishes that the injury or
disease existed before service. 38 U.S.C.A. § 1111 (West
1991); 38 C.F.R. § 3.304(b) (1999); Crowe v. Brown, 7 Vet.
App. 238 (1994).
In Crowe, the U.S. Court of Appeals for Veterans Claims (the
Court) indicated that the presumption of soundness attaches
only where there has been an induction medical examination,
and where a disability for which service connection is sought
was not detected at the time of such examination. The Court
noted that the regulation provides expressly that the term
"noted" denotes only such conditions as are recorded in
examination reports, and that history of pre-service
existence of conditions recorded at the time of examination
does not constitute a notation of such conditions. 38 C.F.R.
§ 3.304(b)(1). Crowe, 7 Vet. App. at 245.
The Court has held that lay observations of symptomatology
are pertinent to the development of a claim of service
connection, if corroborated by medical evidence. See Rhodes
v. Brown, 4 Vet. App. 124, 126-27 (1993). The Court
established the following rules with regard to claims
addressing the issue of chronicity. Chronicity under the
provisions of 38 C.F.R. § 3.303(b) is applicable where
evidence, regardless of its date, shows that a veteran had a
chronic condition in service and still has such condition.
Such evidence must be medical unless it relates to a
condition as to which, under the Court's case law, lay
observation is competent. If the chronicity provision is not
applicable, a claim may still be well grounded if (1) the
condition is observed during service, (2) continuity of
symptomatology is demonstrated thereafter and (3) competent
evidence relates the present condition to that
symptomatology. Savage v. Gober, 10 Vet. App. 488, 495
(1997). A lay person is competent to testify only as to
observable symptoms. A lay person is not, however, competent
to provide evidence that the observable symptoms are
manifestations of chronic pathology or diagnosed disability.
Falzone v. Brown, 8 Vet. App. 398, 403 (1995).
A determination of service connection requires a finding of
the existence of a current disability and a determination of
a relationship between the disability and an injury or
disease incurred in service. Watson v. Brown, 4 Vet.
App. 309, 314 (1994). However, service connection may be
granted for a post-service initial diagnosis of a disease
that is established as having been incurred in or aggravated
by service. 38 C.F.R. § 3.303(d) (1999).
The threshold question is whether the veteran has presented
evidence that his claim is well grounded. See 38 U.S.C.A.
§ 5107(a). A well-grounded claim is a plausible claim.
Murphy v. Derwinski, 1 Vet. App. 78, 81 (1990). A mere
allegation that a disability is service connected is not
sufficient; the veteran must submit evidence in support of
his claim which would justify a belief by a fair and
impartial individual that the claim is plausible. In order
for a claim to be well grounded, there must be competent
evidence of current disability (a medical diagnosis), of
incurrence or aggravation of a disease or injury in service
(lay or medical evidence), and of a nexus between the in-
service injury or disease and a current disability (medical
evidence). See Caluza v. Brown, 7 Vet. App. 498 (1995).
Where the determinative issue involves a question of medical
diagnosis or causation, competent medical evidence to the
effect that the claim is plausible is required to establish a
well-grounded claim. Libertine v. Brown, 9 Vet. App. 521
(1996); Grottveit v. Brown, 5 Vet. App. 91, 93 (1993). A lay
person is not competent to make a medical diagnosis or to
relate a medical disorder to a specific cause. See Grivois
v. Brown, 6 Vet. App. 136, 140 (1994). Thus, lay statements
regarding a medical diagnosis or causation do not constitute
evidence sufficient to establish a well-grounded claim under
38 U.S.C.A. § 5107(a).
The veteran's available service medical records, consisting
of service induction medical examination report in June 1969,
reveal a report of history of nervous trouble; he indicated
that he "didn't do much school work" and that he had
received mental health inpatient treatment previously in
1963. No specific findings of chronic disability or
impairment were noted on clinical evaluation; on the
induction medical examination report it was noted that he was
found acceptable on psychiatric evaluation.
In the May 1998 remand, the Board requested, in pertinent
part, that the RO make an attempt to secure a complete set of
copies of the veteran's service medical records. A review of
the post-May 1998 remand record reveals that all available
service records were received in November 1998. Such records
include a copy of an October 18, 1969 clinical note from W.
Irwin, M.D., showing that he treated the veteran for injuries
to the legs and back after a 25-foot fall from a silo on
August 25, 1969; Dr. Irwin indicated that, as of October 18,
1969, the veteran still had problems with the left knee. An
October 23, 1969 stamp on Dr. Irwin's note indicates that it
was reviewed and considered by a military physician when
determining the veteran's physical profile.
In July 1975, the veteran filed a claim for VA compensation
or pension, claiming entitlement to service connection for
left knee disability, noting that he injured the knee in
1969; he did not suggest that he had any right shoulder or
back disability or problems, or that he experienced any
psychiatric symptoms or impairment.
At an RO hearing in August 1996, the veteran testified that
he did not experience any health problems prior to active
service. During basic training, he reportedly fell off a
"tanker", lost consciousness, and did not exactly remember
what happened. In the fall, he reportedly injured his right
shoulder, back, and head, received some therapy from a
physician and, shortly thereafter, was discharged from the
service. He stated that he continued to have recurrent
problems with the back and right shoulder after his in-
service injury, but noted that he sustained further injury to
the back and the shoulder during post-service employment in
1981. He believed that his psychiatric/psychological
problems had their onset as a result of his in-service fall,
but denied receiving any psychiatric treatment during
service. He indicated that he received intermittent medical
and psychiatric treatment after service, but did not remember
where and when he initially sought psychiatric treatment.
On VA psychiatric examination in June 1997, the veteran
indicated that he fell from a tanker in service and lost
consciousness for about 3 hours; reportedly, he was not
hospitalized but received some medical treatment, was
released back to his unit and, shortly thereafter, was
separated from the service. He indicated that he sustained
further injuries during post-service employment in 1981
requiring intermittent medical treatment; reportedly, he had
not worked since 1991 and received Social Security
Administration (SSA) disability benefits. He indicated that
he received psychiatric treatment since June 1994. On
examination, organic mood disorder with severe depression and
anxiety and Tourette's syndrome were diagnosed.
On VA medical examination in June 1997, status post right
rotator cuff tear, post surgical right shoulder dislocation,
degenerative joint disease of the thoracic spine, and
muscular ligamentous strain were diagnosed.
VA summaries of outpatient psychiatric treatment from
December 1995 to June 1999, prepared by the veteran's
treating psychiatrist and psychologist (with an additional
summary from the psychiatrist covering the period June 1999
to January 2000 and submitted to the Board in January 2000,
cumulative of the December 1995 to June 1999 summaries) and
medical records of treatment for various physical symptoms
and impairments, reveal that the veteran received
intermittent psychiatric treatment since June 1994 and show
diagnoses of psychiatric disabilities including organic mood
disorder with severe depression, anxiety, and somatoform
features, a personality disorder, and Tourette's syndrome;
such records also note diagnoses of disability involving his
right shoulder and low back. During treatment, the veteran
informed his physicians that he was in the service for 4
months and was separated from service because of injuries
sustained therein; he indicated that he fell off a tanker
injuring his back and the right shoulder; he also noted that
he sustained various injuries to the right shoulder and back
during post-service employment in November 1981, and later in
December 1986, requiring extensive medical care.
The aforementioned VA medical records from December 1995 to
January 2000 reveal that the veteran reported having
emotional and mental health problems since his in-service
fall from a tanker at which time he was reportedly rendered
unconscious for several hours; he was unable to provide any
details surrounding the reported in-service injury, but
indicated that he was discharged from the service shortly
after the fall. He indicated that he experienced
psychiatric/psychological symptoms including depression,
anxiety, mood disturbance, explosive and unpredictable
behavior, and poor judgment since his in-service injury. His
psychiatrist indicated that the veteran's psychiatric
treatment was commenced in June 1994; she opined on several
occasions that his psychiatric disability and disabilities of
the right shoulder and low back were etiologically related to
his injuries (including trauma to the brain) during service
in 1969 and that he did not experience any emotional or
physical problems prior to service. In January 1998, the
psychiatrist indicated that the veteran consistently
indicated that he sustained significant injuries during
active service (giving rise to his current psychiatric
disability and disability involving the back and right
shoulder), noting that it was extremely rare for a person to
be discharged from the service after less than 5 months
without a significant reason; she thus suggested that his
current disabilities were the result of in-service head
injury.
Subsequent to the May 1998 Board remand, the RO received in
August 1998 a complete set of the veteran's records from the
SSA. A May 1994 disability determination shows that he was
found disabled, effective in September 1991, due to various
disabilities including right shoulder and back impairment and
numerous emotional/psychiatric problems; SSA evidence
includes extensive records of frequent and elaborate medical
treatment and numerous clinical studies beginning in November
1981, at which time the veteran is shown to have sustained
significant injuries at work. In his November 1992
application for SSA disability benefits, the veteran
indicated that his right shoulder and back impairment had its
onset as a result of industrial injury at work on November
25, 1981. On numerous occasions during medical treatment and
evaluations, he denied history of injury or trauma prior to
November 1981.
Medical records received from the SSA document frequent and
extensive treatment for various disabilities, beginning in
November 1981, showing that he sustained injuries at work in
November 1981 and on several occasions thereafter. On
medical examination of the right shoulder, low back, knees,
and left wrist, conducted in December 1993 for state
industrial insurance purposes, including and reflecting the
examiner's review of medical records and clinical studies
from December 1981 to April 1993, the veteran indicated that
he was employed in special effects for a film production
company in 1981; his duties included preparing tanks to be
filmed and involved activities such as lifting, standing,
walking, bending, twisting, turning, pushing, pulling,
stooping, reaching, kneeling, climbing, and sitting. While
at work on November 11, 1981, he reportedly slipped and fell
off an M-60 tank; he did not recall how he landed, but was
reportedly unconscious and later felt pain "all over;" he
discontinued work and received frequent medical treatment
from numerous providers following this civilian, work-related
injury. The examiner's review of medical evidence reflected,
in pertinent part, the following: right shoulder injury
diagnosed and treated with physical therapy in December 1981;
X-ray studies of the right shoulder from December 1981 to
January 1982, showing no bony pathology, osteoarthritic
changes or changes involving the acromioclavicular joint;
probable right shoulder rotator cuff tear was diagnosed in
January 1982 and surgical treatment was recommended; no
objective evidence of neurologic traumatic injury was shown
during treatment from February to March 1982; X-ray study of
the lumbosacral spine in June 1982 showed no acute fracture,
but there was evidence of spondylosis at L5 and mild (less
than first degree) intervertebral disc space narrowing at L5-
S1. During treatment since 1982, the records showed
objective evidence of right shoulder and back disabilities;
reactive depression was initially diagnosed in July 1982.
The examiner indicated that this was a "most complicated"
case as the medical records were "voluminous" and
documented treatment following the November 1981 injury and
numerous injuries thereafter. He indicated that the veteran
exhibited significant hysteria, hypochondriasis, and
depression making it very difficult for him to evaluate the
extent of his physical disabilities; psychiatric treatment
was recommended (noting that some psychiatric evaluators in
the past felt that the veteran's emotional problems pre-
existed his industrial injury).
The aforementioned SSA records include an October 1990
medical examination report from the City of Hope National
Medical Center (CHNMC) which includes a review of the
veteran's emotional/psychological history. The veteran
indicated that he experienced various symptoms including
compulsive behavior, motor and vocal tics, short temper, and
concentration deficit since childhood; at age 12, he was
reportedly hitting his mother and compulsively calling her
names and was placed in a psychiatric hospital for a year;
treatment reportedly did not significantly change his
behavior. On examination, Gilles de la Tourette syndrome,
attention deficit, hyperactivity disorder, and obsessive-
compulsive disorder were diagnosed.
On VA psychiatric examination in June 1999, including a
review of the claims file (and discussing in detail the
October 1990 medical examination report from the CHNMC
identified above), the veteran indicated that he sustained
various injuries when he fell off a tank in service, but he
indicated that he did not receive any psychiatric treatment
during service or within one year thereafter; reportedly he
initially sought psychiatric treatment in 1977 (but did not
remember where) because his head was "pounding." The
examiner indicated that this was a hard case to evaluate
because the history of the in-service events was reported
only by the veteran and his service medical records did not
corroborate his contention that the claimed in-service fall
resulted in the claimed injuries. On examination and review
of the evidence of record, the examiner opined that the
veteran's early psychiatric disability was not aggravated
during his short period of active service as he did not begin
to receive regular psychiatric treatment until 1994. Organic
mood syndrome and personality disorder were diagnosed.
On VA orthopedic examination in June 1999, including review
of the entire claims file, the examiner indicated that the
history reported by the veteran (suggesting, in pertinent
part, that his right shoulder and back disabilities were the
result of his in-service injury) did not coincide with the
extensive medical evidence of record which referred his
medical problems to a civil, industrial injury in 1981. At
the time of the examination, the veteran did not remember
much about the pertinent medical history, but stated that his
disabilities were the result of in-service injuries rather
than of the employment-related injury in 1981. The examiner
indicated that there was no doubt that the veteran had
chronic right shoulder and back disability but felt that
"most, if not all of his problems," were related to his
1981 industrial accident.
Based on the foregoing, the Board finds that the
preponderance of the evidence is against the veteran's claims
of service connection for chronic acquired psychiatric
disability, and chronic disabilities of his right shoulder
and back. Initially, it is noted that the veteran's
accredited representative suggested in his February 2000
written presentation to the Board, that the May 1998 remand
orders had not been met and another remand was required
consistent with Stegall v. West, 11 Vet. App. 268 (1998)
(remand by the Board confers on the claimant, as a matter of
law, the right to compliance with the remand orders). Based
on a careful review of the post-remand record, the Board is
of the opinion that the May 1998 remand orders were fully
satisfied and another remand of this case is unwarranted,
notwithstanding the veteran's representative's February 2000
argument to the contrary.
Specifically, the representative argued that instruction
Number 5 of the Board remand had not been fully accomplished
(requesting a thorough VA psychiatric examination to
determine the nature and etiology of any psychiatric
disability found). However, a VA psychiatric examination was
performed in June 1999, it included and reflects the
examiner's review of the pertinent evidence, and the examiner
opined, after discussing the veteran's pre-service history of
psychiatric symptomatology, that the psychiatric disability
was not aggravated by active service. Thus, the Board is
satisfied that the duty to assist has been met in this case,
and that the May 1998 remand request was complied with in a
satisfactory manner.
With regard to the claimed psychiatric disability, the
evidence of record indicates that the veteran may have
experienced emotional/psychiatric problems since childhood
and may have received inpatient psychiatric treatment prior
to service. However, the only evidence of pre-service
symptoms/impairment consists of the history as reported by
the veteran and is not corroborated by contemporaneous
medical evidence (the Board notes that although the veteran
reported a history of nervous trouble on service entrance
medical examination, no clinical findings were noted on such
examination); however, a VA psychiatrist considered such
history on psychiatric examination in June 1999, indicating
that any pre-service disability was not aggravated by
service; he clearly indicated that psychiatric disability was
not evident in service or for many years thereafter, as the
veteran's psychiatric treatment did not commence until 1994.
Thus, while the date of onset of his psychiatric disability
is not entirely clear, the entirety of the evidence shows
that it was not incurred in or aggravated by the veteran's
brief period of active service.
The Board notes that the veteran's treating VA psychiatrist
indicated that he received regular psychiatric treatment
since June 1994 and opined, on many occasions, that his
psychiatric disability (and right shoulder and back
disabilities) were etiologically related to an in-service
fall where he is said to have sustained multiple injuries
including brain trauma; yet, contemporaneous records do not
show that any such injury in fact occurred after an in-
service fall; the evidence shows that he did fall in service
injuring his legs and back and only left knee impairment
continued to be present at the conclusion of medical
treatment in service. Review of the evidence from his
treating psychiatrist clearly shows that her conclusions were
based on history reported by the veteran, and that she did
not have the benefit of reviewing the entire claims file.
She apparently began treating him long after service (in June
1994) at which time he already was status post multiple
injuries and trauma sustained during post-service employment.
The Board notes that the psychiatrist opined that the
veteran's psychiatric disability was likely the result of
brain trauma in service, yet the entirety of the medical
evidence shows that he was in relatively good health from the
time of service separation until his on-the-job injury in
November 1981. Specifically, he is not shown to have
received medical treatment prior to November 1981 and, once
treatment was commenced, he continued to undergo frequent and
elaborate treatment from a multitude of providers. Not once
during the course of such treatment (or in conjunction with
his claim for SSA disability benefits) did he suggest that
psychiatric disability may be related, in any way, to active
service or any incident occurring therein. Thus, while his
treating psychiatrist is certainly qualified to opine that
his psychiatric disability may be related to brain trauma,
the evidence of record simply does not show that such trauma
(or any other event giving rise to psychiatric disability)
occurred in service; the evidence does however show that he
may have experienced mental health impairment prior to
service, that any pre-service impairment was not aggravated
during service, and that he sustained significant injury in a
fall during post-service employment and required frequent and
extensive medical and psychiatric treatment thereafter.
With regard to the claimed right shoulder and back
disabilities, the service records show that he did injure the
back in a fall in service and received medical treatment
prior to his service separation; yet, it is clear that any
back symptom or impairment which he may have incurred in that
fall resolved during treatment and was not evident at the
time of service separation (or for many years thereafter).
Although he was separated from service only a few months
after induction, due to "disqualifying defects,"
contemporaneous evidence shows that the disqualifying defects
were not related to psychiatric, right shoulder, or back
impairment (as was suggested by the veteran's treating
psychiatrist who, as indicated above, does not appear to have
reviewed the claims file and the voluminous medical record
contained therein). The entire post service evidence, as
discussed in detail above, shows that he did not experience
any problems referable to the right shoulder or back for many
years after service separation; he sustained an injury at
work in November 1981 and received extensive medical
treatment (including right shoulder surgery) since that time.
On initial medical examination following the injury in
November 1981, there was no clinical evidence of right
shoulder or back impairment, and such impairment is shown to
have developed following that accident. The Board observes
that, at the time of his work-related accident in November
1981, the veteran was employed as a stage hand, working for a
film production company which required significant physical
exertion; yet, there is no indication that he experienced any
functional limitation or right shoulder or back impairment at
work prior to the November 1981 injury. Finally, on many
occasions during medical treatment after 1981, the veteran
denied history of any back or right shoulder problem prior to
November 1981; he never suggested during treatment that right
shoulder or back impairment existed due to an active service
injury.
As indicated above, the veteran's treating VA psychiatrist
opined on several occasions that his right shoulder and back
disabilities were the result of his in-service injury.
However, as discussed above, such conclusions were based on
history as reported by the veteran (uncorroborated by
contemporaneous medical evidence). A thorough VA orthopedic
examination was performed in June 1999, and the examiner
opined that "most, if not all" of the pertinent problems
were related to a work-related injury in 1981, rather than to
any in-service event. As noted above, the medical evidence
of record indicates that in fact all of his right shoulder
and back impairment is due to post-service causes as no
pertinent pathology was evident prior to November 1981 (while
he did injure the back in service, contemporaneous medical
evidence does not show that it produced chronic disability).
The Board is mindful of the veteran's own contentions that
his psychiatric disability and right shoulder and back
disabilities had their onset in active service. However, to
establish service connection, competent medical evidence
providing a nexus between the current disability and service
is required. See Caluza, 7 Vet. App. 498; see also,
Rabideau, 2 Vet. App. 141. While his testimony concerning
in-service and post-service manifestations cannot be ignored,
as he is competent as a layman to describe the symptoms as he
has experienced them, see Cartright v. Derwinski, 2 Vet.
App. 24 (1991), but as a lay person, he is not competent to
make a medical diagnosis or to relate a medical disorder to a
specific cause. See Grivois, 6 Vet. App. at 140, citing
Espiritu, 2 Vet. App. at 494. Thus, he is not competent to
conclude, in clinical terms, that in-service injury resulted
in any current chronic disability.
Moreover, the evidence of record does not show, nor is it
contended by or on behalf of the veteran, that the claimed
disabilities are related to combat service; neither is it
mentioned that he engaged in any combat with the enemy during
his brief period of active service; thus, 38 U.S.C.A.
§ 1154(b) (West 1991) is inapplicable in this case.
In reaching its decision, the Board has considered the matter
of resolution of the benefit of the doubt in the veteran's
favor; however, it is noted that application of the rule is
only appropriate when the evidence is evenly balanced or in
relative equipoise. 38 U.S.C.A. § 5107(b); Gilbert v.
Derwinski, 1 Vet. App. 49, 53-56 (1990). Such is not the
case in this instance where the weight of the evidence is to
the effect that the veteran's psychiatric disability and
disabilities involving the right shoulder and the back were
not incurred in or aggravated during service.
ORDER
Service connection for chronic psychiatric disability is
denied.
Service connection for chronic right shoulder disability is
denied.
Service connection for chronic back disability is denied.
J. F. Gough
Member, Board of Veterans' Appeals